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Dyspepsia or indigestion is a severe uncomfortable pain in the stomach accompanied by heartburn, burping, flatulence and vomiting. Symptoms of dyspepsia include upper abdominal fullness, bloating, nausea, belching and heartburn. Often dyspepsia is caused due to GERD. In some persons, dyspepsia symptoms are due to medications for high blood pressure and angina. Corticosteroids and NSAIDs can cause dyspepsia. Gallstones or duodenal ulcers can cause dyspepsia. Alcohol, caffeine and smoking aggravate the dyspepsia condition. Sometimes food allergies might trigger indigestion. Stress and anxiety contribute to dyspepsia symptoms. There is tenderness on palpitation of abdomen.

If there is blood in vomit or abdominal swelling, further investigations would be necessary. Tests are done to detect the presence of H. pylori bacteria. A gastrointestinal endoscopy can help detect peptic ulcer disease or other ulcerations with tissue and culture specimen. Barium studies aid in detecting any gastrointestinal disease. Treating dyspepsia is based on the causative factors. Antacids provide immediate relief from dyspepsia symptoms. They might be combined with alginates to reduce acid reflux. Lifestyle changes help in reducing discomfort and recurrence of indigestion symptoms. Cutting on fatty food and tea and coffee provides relief. Losing weight and reducing stress help tackle chronic indigestion symptoms.


Physicians who specialize in the diagnosis and treatment of the digestive system or gastrointestinal tract are gastroenterologists. When they specialize to treat children in the same area, they are termed as pediatric gastroenterologist. They treat conditions such hepatitis, colon or rectal cancer, ulcerative colitis and Crohn's disease. A gastroenterologist must complete four years of degree, four years of medical school, three years residency in internal medicines and later specialize in gastroenterology for a period of two to three years. Certification from a recognized board is necessary.

Role of gastroenterologist

  • Diagnose and offer medical treatment for any kind of disorder in the gastrointestinal tract.
  • Order for blood tests, x-rays, endoscope checks of the stomach called gastroscopy or for the large intestine called colonoscopy depending on the patient's illness.
  • Assist a surgeon in exactly locating the area of problem that needs treatment in the gastrointestinal section.
  • They follow up digestive system disorders that include esophagus, small and large intestine, stomach, pancreas and the liver. They also follow up on symptoms of heartburn, indigestion, ulcers etc following an operation.

Modern techniques and gastroenterologist

  • Use of ultra high frequency in endosonography gives better understanding of any lesions formed.
  • Measuring of myoelectric and contractile activity in the gastrointestinal tract, esophageal and anal manometry to understand constipation, nausea, abdominal pain etc better in any patient.
  • Electrogastrography and few other modern techniques have made it easier to understand the esophageal transit in patients easier.

Pancreatic Enzyme Replacement Therapy

Pancreatin is a mixture of pancreatic enzymes, lipase, amylase and protease. These enzyme supplements assist in digestion of fat, carbohydrates and proteins. Now, a replacement therapy for pancreatic enzyme involves taking the digestive enzymes that are needed in the form of a tablet or capsule to enable digestion.

Why Pancreatic enzyme replacement ?

Pancreas do not produce the enzymes that are needed to digest food and absorb the nutrients, if you suffer exocrine pancreatic insufficiency. In such cases, pancreatic enzyme replacement therapy (PERT) can help manage the condition and prevent malabsorption and gastric discomfort, if taken properly. This is more so in those with cystic fibrosis, the need for pancreatic enzyme replacement therapy to prevent malnutrition. Whenever food is consumed, enzyme preparation needs to be taken and the dose will be adjusted according to the food consumed.

What are pancreatic enzyme supplements?

Pancreatic enzyme supplements are extracts from pig pancreas glands. In fact, all enzyme replacement products are currently produced from pork derived ingredients. There are no alternatives available. While the Jewish Rabbi has approved pancreatic enzymes, for Muslim patients it has been advised by their religious heads that if no medicines are available, and the ones containing prohibited substances are suitable to cure illnesses or diseases, then that prohibited substance should be prescribed and taken by the patient.

Symptoms associated with pancreatic enzyme insufficiency

Patients with these symptoms should discuss with their medical team whether taking supplemental pancreatic enzymes may be beneficial for them.

  • Indigestion / feeling of indigestion
  • Cramping after meals
  • Large amounts of gas
  • Foul smelling stools
  • Floating or greasy fatty stools
  • Orange, yellow or light colored stools
  • Frequent stools / loose stools
  • Weight loss

How does PERT work?

Pancreatic supplements are capsules that contain a mixture of digestive enzymes. These include lipase to break down fat, protease to assist in digestion of protein and amylase for carbohydrates. Normally, two capsules are prescribed during the course of a meal and sometimes even three or more depending upon the patient's condition, the product and the concentration. Also, appropriate dosage of PERT tends to vary from one to another as other variables such as residual function of the pancreas, which can worsen over time, size and fat contents of meals taken, and goal of PERT for the patients, whether it is reducing bloating or eliminating diarrhea, are considered.

Doctors tend to start with a low dose of PERT and increase as and when necessary. As enzyme doses vary from person to person, a starting dose of 50,000 to 75,000 units of lipase with a meal and 25,000 units with a snack is given.

Preparation of Pancreatic enzyme

Pancreatic enzyme includes Creon, Nutrizym, Pancrease, and Pancrex. These come in capsule form, in two sizes, as 10,000 units for children and 25,000 units for adults. Each capsule sports a number and a letter to indicate the strength of the dose. Do not be alarmed by the high capsule units as it only relates to the amount of lipase unit it contains, and healthy pancreas will release about 720,000 lipase units during every meal.

How to use PERT?

Normally dieticians recommend the amount of intake of PERT and it starts on a low dose and is gradually increases until the symptoms exhibited are brought under control. Capsules should be taken with all food directly, with the first mouthful of food. This includes meals, snacks, and milky drinks, milk based supplements, over the counter shakes, homemade or prescription drinks.

If you skip taking enzymes with every meal or snack, the possibility is that malabsorption may recur. Capsules can be swallowed with a cold drink as swallowing them with hot drink can be less effective as the enzymes tend to get damaged at high temperatures. The capsules should be swallowed as a whole and should not be crushed or chewed. In case you are consuming a large meal, then take half the enzymes at the beginning and the other half in the middle of the meal.

As for the duration of taking pancreatic enzymes, if your pancreas are damaged by cancer and have been removed through surgery, then you have to take pancreatic enzymes for life. Most patients will need to take these enzymes for the rest of their lives as post surgery, the pancreatic function can decline. However, the dosage may be increased or decreased suitably. You should not take enzyme supplements on:

  • An empty stomach
  • With drinks that contain less than half milk, such as tea, non-milky coffee, fruit, squashes and fizzy drinks.
  • With small quantities of fruit, vegetables, dried fruit, fat-free sweets and mints.
  • With small quantity of food such as just a square of chocolate or a small plain biscuit.

Side effects of PERT

Some could experience side effects from enzyme replacement. The most frequent effects are constipation, diarrhea, nausea, and abdominal discomfort. These settle over a period of time, and if it does not settle down, then try a different enzyme brand. Remember, while using PERT:

  • Pancreatic enzymes cannot withstand high temperatures and they can get damaged. They should be stored at room temperature.

  • Do not store enzymes in warm places, near radiators, in cars or in trouser pockets. Carry them in a pill box or small containers as the whole bottle need not be carried.

  • Never mix enzymes with hot drinks.

Tags: #Dyspepsia #Gastroenterologist #Pancreatic Enzyme Replacement Therapy
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Collection of Pages - Last revised Date: April 22, 2024